RECORD OF PROCEEDINGS
AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:	DOCKET NUMBER:  BC-2002-02301
		INDEX CODE:  108.02
		COUNSEL:  

		HEARING DESIRED:  Not Indicated

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APPLICANT REQUESTS THAT:

1.  Her discharge for disability reasons with severance pay be changed to reflect that she was permanently retired for disability reasons with a rating of 50%.

2.  In the alternative, her records be corrected to show she was placed on the Temporary Disability Retired List (TDRL) with a disability rating of 50%.

3.  She receive all back pay an allowances accordingly.

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APPLICANT CONTENDS THAT:

She underwent a Medical Evaluation Board (MEB) on 10 Feb 00.  The board practitioner, not versed in psychiatry, relied almost exclusively upon the report of an Air Force clinical psychologist.  Her clinical psychologist diagnoses were:  Axis I: somatization disorder, Post Traumatic Stress Disorder (PTSD), depressive disorder; and Axis II: borderline and paranoid personality traits.  A civilian psychiatrist who saw her on 15 Dec 99, gave her no diagnosis of Axis II.  Diagnosis of PTSD and depressive disorder had been rendered as early as 1995.  The Informal Physical Evaluation Board (IPEB) recommended disability with a 30% rating.  However, the 30% rating was reduced to 10% by ascribing 20% to predisposing contributing factors.  These factors were noncompensable personality traits that the board opined affected the severity of her condition.  She accepted the results and separated in May 2000.  On 31 Jan 02, the Department of Veterans Affairs (DVA) awarded her a service-connected disability rating of 50%.  She applied to the DVA nine days after separation.  

Her acceptance of the 10% disability rating was not an informed decision.  Her representative failed to properly advise her of the highly speculative nature of the IPEB decision.  She had nothing to lose by seeking a Formal PEB.  At no time prior to 7 Feb 00 had any practitioner provided a diagnosis on Axis II.  In fact, the diagnosis by the clinical psychologist is a diagnosis of traits without any diagnosis of a personality disorder.  Therefore, up to the MEB there was no mention of Axis II, yet the IPEB was willing to deduct 20% from a diagnosis on AXIS I that had been diagnosed since 1995.  It is beyond speculation for the IPEB to say that but for these "traits" her Axis I conditions would have been mild when there is no factual analysis in the record.  Further, there is no suggestion of partial remission of the PTSD in the record.  She was dysfunctional, and under the Veterans Affairs Schedule for Rating Disabilities (VASRD) her dysfunction was "considerable" at 50%.  When she left the Air Force, she could not function in her job.  It is a perversion to utilize a last minute diagnosis of "traits" to deny her retirement, particularly when that diagnosis did not come from a psychiatrist.  

In support of her request, applicant provided her counsel's brief, documentation associated with her disability evaluation system processing, and documentation associated with her DVA rating decision.

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STATEMENT OF FACTS:

Applicant enlisted in the Regular Air Force on 21 Jan 94.  She was progressively promoted to the grade of senior airman, having assumed that grade effective and with a date of rank of 21 Jan 97.

An MEB was convened on 1 Feb 00 and referred her case to an Informal Physical Evaluation Board (IPEB) with a diagnosis of Axis I: somatization disorder, PTSD, chronic and partial remission, depressive disorder not otherwise specified; and Axis II: borderline and paranoid personality traits.  On 3 Mar 00, the IPEB found her unfit for further military service and recommended she be discharged with severance pay with a combined compensable rating of 30%, less predisposing contributing factors of 20%, leaving a rating of 10%.  The applicant agreed with the findings and recommended disposition of the IPEB.  On 1 May 00, she was discharged with a compensable rating of 10%.  She served 6, years, 3 months, and 11 days on active duty.

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AIR FORCE EVALUATION:

The BCMR Medical Consultant recommends denial.  The Medical Consultant states at the time of her discharge she did not require hospitalization or antidepressant medications; however, she was experiencing occupational difficulty.  Her PTSD had it's roots in her history of child abuse and a subsequent physically and emotionally abusive marriage that began 6 years before entering active duty and ended 2 years after she entered active duty.  There is no documented evidence of PTSD until a year after entering active duty.  Although the severity of her somatization disorder and other conditions was determined to be unfitting at 30%, the presence of maladaptive personality traits (noncompensable and nonratable) were felt to be significant contributors to the severity of her primary diagnoses and were the basis for the reduction of her final disability rating.  The applicant contests the reduction contending the maladaptive personality traits were not diagnosed until October 1999 and that these are traits comparable to a normal individual' personality traits.  She in fact had maladaptive personality traits in 1995 as listed on Axis II of her psychiatric diagnosis and reflected again in 1997 and 1999.  Although she was not diagnosed with a personality disorder, the listed traits are nevertheless abnormal.  The civilian psychiatrist interviewed the applicant only once and without the benefit of having her medical records or the benefit of knowledge of extensive occupational and social historical information available to the Air Force psychologist.  The issue is whether her abnormal, maladaptive personality traits were causative, or substantially contributory to the social and industrial adaptability impairment resulting from her total neuropsychiatric condition.  Her maladaptive personality traits are likely inextricably intertwined with her PTSD.  Her PTSD represents an existing prior to service condition that in combination with her maladaptive personality traits is significantly responsible for her primary unfitting diagnosis of somatization disorder and the social and industrial adaptability.  

The Medical Consultant evaluation is at Exhibit C.

AFPC/DPPD recommends denial.  DPPD states she is using the DVA rating decision as justification for a higher rating and disability retirement.  For an individual to be considered unfit for military service, there must be a medical condition so severe that it prevents performance of any work commensurate with rank and experience.  The mere presence of a medical condition does not qualify a member for disability discharge, retirement, or compensation.  Once an individual has been declared unfit, the service Secretaries are required by law to rate the condition based upon the degree of disability at the time of permanent disposition.  The DVA may rate any service-connected condition based on the seriousness of the medical conditions throughout her life span.  This is why the services and DVA ratings may disagree.  The applicant was treated fairly throughout the military DES process, she was properly rated under federal disability guidelines at the time of her evaluation, and she was afforded the opportunity for further review as provided by federal law and policy.    

The DPPD evaluation is at Exhibit D.

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APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

Counsel states the distinction between the DVA and military rating systems is irrelevant in this case.  The diagnostic elements of somataform disorder, chronic depression and PTSD, which gives rise to disability ratings of 30% or above, do not change between the DVA and the military.  She received 30% for Axix I, which was reduced to 10% by the PEB due to contributions from a personality disorder on Axis II.  She was actually at 50% on the date of her PEB.  The 30% was actually too low based on the clinical data.  Contrary to the advisory opinion there was no evidence she got worse from her date of separation of 3 Mar 00, to her first DVA exam on 14 Apr 01.  Medication use is not an indication of a worsening condition, rather it is within physician discretion.  The DVA effective date is 2 May 00 and PTSD and somataform disorder were also part of the diagnoses and were independent of depression.  The issue is how much do you deduct for the personality disorder after giving effect to the actual rating for PTSD, somataform disorder and depression.  Fifty percent is an accurate value.  If 20% reduction is appropriate for the personality disorder, that still leaves a 30% disability.  How much an Axis II personality disorder quantatively contributes to an Axis I condition is at best a guess.  What is certain is that the Axis I conditions were, upon her discharge, ratable at 50%.  Counsel's response is at Exhibit 
F.

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THE BOARD CONCLUDES THAT:

1.  The applicant has exhausted all remedies provided by existing law or regulations.

2.  The application was timely filed.

3.  Insufficient relevant evidence has been presented to demonstrate the existence of error or injustice.  We took notice of the applicant's complete submission in judging the merits of the case; however, we are not persuaded by the applicant's contentions that the disability processing or the rating she received at final disposition of her case were in error or contrary to the governing Air Force regulations, which implement the law.  After a thorough review of the evidence of record and the applicant's submission, we are not persuaded by counsel's contentions that the applicant's condition at final disposition warranted a rating higher than a rating of 30%.  With respect to the issue of the applicant's assigned rating as compared to the rating assigned by the DVA, we feel it is important to note that the services assign ratings based on the degree of impairment of performance or duties at the time of disposition, while the DVA rates service-connected conditions on the basis of social and industrial adaptability.  Therefore, it is entirely possible that the applicant's unfitting condition was rated at 30% while she received a higher rating from the DVA.  We agree with the Air Force offices of primary responsibility that the applicant was properly rated under federal disability guidelines and adopt their rationale as the basis for our conclusion that the applicant has not been the victim of an error or injustice.  In the absence of persuasive evidence to the contrary, we find no compelling basis to recommend granting the relief sought in this application.

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THE BOARD DETERMINES THAT:

The applicant be notified that the evidence presented did not demonstrate the existence of material error or injustice; that the application was denied without a personal appearance; and that the application will only be reconsidered upon the submission of newly discovered relevant evidence not considered with this application.

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The following members of the Board considered AFBCMR Docket Number BC-2002-02301 in Executive Session on 16 Mar 04, under the provisions of AFI 36-2603:

The following documentary evidence was considered:

    Exhibit A.  DD Form 149, dated 19 Jul 02, w/atchs.
    Exhibit B.  Applicant's Master Personnel Records.
    Exhibit C.  Letter, BCMR Medical Consultant, dated 24 Feb 03.
    Exhibit D.  Letter, AFPC/DPPD, dated 4 Apr 03.
    Exhibit E.  Letter, SAF/MRBR, dated 11 Apr 03.
    Exhibit F.  Letter, Counsel, dated 25 Jun 03.